Percutaneous nephrolithotomy with holmium: Yttrium-aluminum-garnet laser and fiber guider—report of 349 cases

Abstract

Objectives To assess the efficacy and safety of holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy for percutaneous nephrolithotomy in a cohort of 349 consecutive procedures. Methods We retrospectively reviewed the charts of 334 patients who had undergone 349 percutaneous nephrolithotomy (PCNL) procedures conducted at our hospital from January 2001 to March 2004 in which the holmium:YAG laser with a self-made fiber guider was used for lithotripsy. Results The average patient age was 54.1 years, and the average stone size was 3.3 ± 1.8 cm. The average operative time was 99 ± 38 minutes, and the average postoperative hospital stay was 4.0 ± 2.3 days. The overall stone-free rate was 83.7%. The postoperative urinary tract infection rate was 7.2%. The postoperative transfusion rate was 2.0%. The holmium:YAG laser was effective against all kinds of stones, but sometimes it was time consuming to use the holmium:YAG laser to disintegrate a very large stone. Thirteen PCNLs (3.7%) to treat large complete staghorn stones were performed in combination with a pneumatic lithotriptor. Of the 349 procedures, 152 (43.6%) had bloodless tracts afterward, and all 152 procedures had been performed with the nephrostomy tube-free modification. Conclusions The holmium:YAG laser is an effective and safe lithotriptor for most percutaneous stone surgery. However, in patients with a very large stone burden, the combination of this technology with another, more powerful, intracorporeal lithotriptor may be necessary.